| Autor: |
Litman, F R, Ahronovich, M D, Baron, I S, Erickson, K, Baker, R |
| Zdroj: |
Pediatric Research; November 2010, Vol. 68 Issue: 1, Number 1 Supplement 1 p588-588, 1p |
| Abstrakt: |
Background and aims: Birth at 23 weeks gestation is at the threshold of viability and associated with high mortality and morbidity rates. Survivors are predicted to have moderate-to-severe neurodevelopmental impairments but these have not been well-described. Our aim was to describe cognitive and behavioral outcomes at early school age in these at-risk children.Methods: We assessed 5 males at age 6 who were born at our hospital 2000-2003 at 23 weeks (birth weights: 482-660 g). Standardized neuropsychological and parental report measures were administered, and scores corrected for prematurity.Results: Survival-to-discharge rate was 56% for 23 weekers born 2000-2003 at our NICU. Compared to normative data, our participants' mean Differential Ability Scales-II General Conceptual Ability was 89±7.59 (range 81-100); composite scores were Verbal=94.8±12.36, Nonverbal Reasoning=92.0±8.12, but Spatial=85.4±10.88. None required special education. Parental behavioral ratings indicated three were intact for internalizing problems, externalizing problems, behavioral symptoms, and adaptive skills; two at-risk for externalizing problems, one also for behavioral symptoms and one with significantly poor adaptive skills.Conclusions: Although resuscitation of extremely early gestation neonates is not universally endorsed, low average (80-89)/average (90-109) functioning can be expected for some born at 23 weeks; severe impairment is not certain. Resuscitation decisions are difficult without knowledge of the best predictors of adequate functional outcome. Risk of spatial dysfunction, hyperactivity, attention problems, and ineffective activities of daily living may be greater in this select population, requiring early interventional therapies in preparation for school entry. Further study of these fragile survivors is warranted. |
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